Pathologica 4-07.pdf - Pacini Editore

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Unusual thymic carcinoma with hepatic
metastases? Report of one case
M. Marino, L. Lauriola *
Department of Pathology, “Regina Elena” Cancer Institute,
Rome, Italy; * Department of Pathology, Catholic University
of Rome, Italy
Introduction. Spread of Thymic Epithelial Tumours (TET)
outside the thoracic cavity is unusual, and usually associated
to Thymic carcinoma. The morphological features and immunohistochemical
markers of thymic origin actually available,
however, are scant, as well as it is difficult to establish
a clear cut thymic origin of a metastatic nodules outside the
mediastinum, particularly when the “cortical” lymphocytic
component usually associated to the rare metastatic thymomas
is absent. We report here a case of a thymic carcinoma
with synchronous hepatic metastases.
Methods. A female patient, aged 39 years, was found to have
a mass in the anterior mediastinum synchronous with liver
nodules. An hepatic biopsy showed an epithelial tumor positive
to CK7 and Cam5.2 and negative to CK20, Chromogranin,
TTF1 and Ca125. No further markers were applied to
the small tissue fragment. A TC-guided FNAC of the mediastinal
mass also showed epithelial cells CK19+, EMA+ and
TTF1-. The patient underwent thymectomy after neoadjuvant
therapy, and in addition she underwent partial hepatectomy
The thymic tumor and the hepatic nodules showed the same
morphological and immunohistochemical features: the tumor
and the metastatic nodules were formed by large cells with
huge vescicular or with multiple nuclei and large nucleoli.
Tumor cells were CD5+, CK19+ and CD117+, and negative
for neuroendocrine markers and for HepPar1.
Conclusions. The anterior mediastinal mass showed features
of an unusual epithelial tumor with huge cells of “cortical”
thymic type, positive to CK19, as usually thymoma epithelial
cells (EC) do. In addition, the EC showed the CD5 positivity
reported for thymic carcinoma of squamous type, and a
CD117 positivity (cytoplasmic and membrane staining) also
reported for thymic carcinomas. The case is particular in that
the mediastinal tumor and the hepatic metastases showed features
of both thymoma and thymic carcinoma, thus establishing
a correlation between the differently located neoplasias.
CXCR4/CXCL12 axis and VEGF are critical for
Uveal melanoma progression
R. Franco, S. Scala * , S. Staibano ** , M. Mascolo ** , G. Ilardi
** , A. La Mura *** , G. Loquercio, E. Fontanella, G. Botti,
G. de Rosa **
S.C. Anatomia Patologica, Istituto dei Tumori “Fondazione
G. Pascale”, Napoli; * S.C. Immunologia, Istituto dei Tumori
“Fondazione G. Pascale”, Napoli; ** Dipartimento di
Scienze Biomorfologiche e Funzionali, Università “Federico
II”, Napoli; *** S.C. Anatomia Patologica, Azienda Ospedaliera
“A. Cardarelli”, Napoli
Uveal melanoma is the most common ocular tumor of adults.
Almost 50% of uveal melanoma patients die of metastatic
disease. The peculiar metastatisation in uveal melanoma
through emathogen dissemination highlight the role of
neoangiogenesis and migration, in which CXCR4/CXCL12
axis and VEGF play an important function.
CXCR4-CXCL12-VEGF were detected by immunohistochemistry
in 53 samples of uveal melanoma. Correlations
with main clinic-pathological features were evaluate, as well
as their potential impact on overall survival and disease-free
survival. Moreover immunohistochemical and mRNA expression
were evaluated in liver metastasis of two patients in
our series.
CXCR4 staining was present in 22 cases (41.4%) and significantly
correlates with neoplastic progression and VEGF expression,
while CXCL12 expression was positive in 23 cases
(43.4%) and significatively correlated to tumor diameter and
to the epithelioid-mixed cytotype. VEGF expression was
positive in 21 (39.6%). Neither single protein expression neither
their combined expression did not affect DFS and OAS.
Moreover liver metastasis showed increased CXCR4 expression.
Although CXCR4-CXCL12-VEGF expression in uveal
melanoma failed to identify high risk patients, cross-interaction
of CXCR4-CXCL12 axis and VEGF seem to have a role
in uveal melanoma progression, adding prognostic information
on this group of patients.
Pseudoparasites in histological specimens
189
F. Rivasi, S. Pampiglione *
Department of Pathologic Anatomy and Forensic Medicine,
Section of Pathological Anatomy, University of Modena and
Reggio Emilia, Modena, Italy; * Department of Veterinary Public
Health and Animal Pathology, University of Bologna, Italy
Introduction. Various materials including unfamiliar cell fragments,
abnormal conglomerates, mineral concretions, Curschmann
spirals, extraordinary elements, artefacts and foreign
material of vegetable origin, will be encountered by pathologist
during tissues examination 1 . Unfortunately, because of the
wide range of possibilities, it is not always easy to identify these
structures that sometimes show one vague or even strong resemblance
to parasitic organisms or their eggs 2 . Differential
diagnosis from this material with parasites should be therefore
considered. The aim of this paper is to focus on this diagnostic
problem by illustrating histological findings with the
presence of these structures.
Materials and methods. The investigation was carried out
between January 2000 and June 2007. 100 formalin-fixed,
paraffin embedded histological tissue specimens (60 appendicectomy,
12 intestinal wall surgical specimens, 18 colectomy,
and omentectomy, peritoneal biopsies, pleuropulmonary
biopsies, conjunctival biopsies and 2 prostatectomy
cases, respectively), exhibiting sometimes acute
and/or chronic granulomatous inflammation with evidence
of elements mimicking parasites, were retrieved from the
archives of the Anatomic Pathology of Modena. 58 patients
were females while 42 were males, ages raging from 24
and 78 years (mean 65 years). The histological specimens
were routinely processed and stained. Each specimen was
also assessed for the type and number of inflammatory cells
in order to evaluate the degree of the pathological changes
correlated to the presence of the pseudo-parasitic elements
and to the clinical data. The histopathological slides
were reviewed by the authors, one being a histopathologist
(FR), the other (SP) a parasitologist, who paid particular
attention to the histological and possible parasitological
aspects.